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EKG Interpretation Paramedic Instructor Stamford Emergency Medical Services Adam Cadan Alex Cadan 09/18/00.

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Presentation on theme: "EKG Interpretation Paramedic Instructor Stamford Emergency Medical Services Adam Cadan Alex Cadan 09/18/00."— Presentation transcript:

1 EKG Interpretation Paramedic Instructor Stamford Emergency Medical Services Adam Cadan Alex Cadan 09/18/00

2 Ask yourself the following: 1. Is the rate fast or slow? 2. Is there one P for every QRS? 3. Are the Ps upright and present? 4. Is the PR interval ? (<.20) 5. Whats the QRS width? (<.12) 6. Whats the rhythm? Regular Regular Regularly Irregular Regularly Irregular Irregularly Irregular Irregularly Irregular 7. Any funny looking complexes? PACs PACs PVCs PVCs PJCs PJCs Unifocal Unifocal Multifocal Multifocal

3 Key facts about PR interval Time it takes for the atria to depolarize and pass its message to the ventricles Time it takes for the atria to depolarize and pass its message to the ventricles From the beginning of the P-wave to the beginning of the QRS. Should be 0.12 to 0.21 sec (or three to five little squares) From the beginning of the P-wave to the beginning of the QRS. Should be 0.12 to 0.21 sec (or three to five little squares) Prolonged in heart block Prolonged in heart block Short PR, conditions where there is an abnormality in the fibrous insulating ring…electrical message gets past the AV node quickeri.e. WPW Short PR, conditions where there is an abnormality in the fibrous insulating ring…electrical message gets past the AV node quickeri.e. WPW

4 Key facts about QRS complex Spread of depolarization from the AV node to all parts of the ventricles takes sec Spread of depolarization from the AV node to all parts of the ventricles takes sec If QRS width > 0.12sec (three small squares) it suggests a defect in the conduction system If QRS width > 0.12sec (three small squares) it suggests a defect in the conduction system Q wave pathological or physiological (Old MI signature) Q wave pathological or physiological (Old MI signature)

5 Key facts about P-wave Initiated by the SA node Initiated by the SA node Travels inferiorly + Right to left Travels inferiorly + Right to left SA node normally determines the heart rate SA node normally determines the heart rate P-waves should be upright in I, II, & V2 -V6 P-waves should be upright in I, II, & V2 -V6

6 Key facts about ST segments Elevation of >1mm implies infarction Elevation of >1mm implies infarction Depression of >0.5mm implies ischemia Depression of >0.5mm implies ischemia Widespread ST elevation occurs in pericarditis Widespread ST elevation occurs in pericarditis

7 Rates: Sinus Rhythm……………… /min Sinus Rhythm……………… /min Sinus Bradycardia…………..rate < 60/min Sinus Bradycardia…………..rate < 60/min Sinus Tachycardia………...rate > 100/min Sinus Tachycardia………...rate > 100/min Junctional…………………… /min Junctional…………………… /min Accelerated Junctional……..rate > 60/min Accelerated Junctional……..rate > 60/min Idioventricular…………………20-40/min Idioventricular…………………20-40/min Accelerated Idioventricular……..rate > 40 Accelerated Idioventricular……..rate > 40

8 First item to look at is the "Time Markings". First item to look at is the "Time Markings". Once your able to identify a six second time period, rate determination is easy! Once your able to identify a six second time period, rate determination is easy!

9 1 small box is 40 milliseconds, or.04 1 small box is 40 milliseconds, or.04 2 small boxes is 80 milliseconds, or.08 2 small boxes is 80 milliseconds, or.08 3 small boxes is 120 milliseconds, or.12 3 small boxes is 120 milliseconds, or.12 4 small boxes is 160 milliseconds, or.16 4 small boxes is 160 milliseconds, or.16 5 small boxes is 200 milliseconds, or.20 5 small boxes is 200 milliseconds, or.20 Couldnt think of a name for this slide!

10 Is the rate fast or slow? Is there one P for every QRS? Are the Ps upright and present? Is the PR interval ? (<.20) Whats the QRS width? (<.12) Whats the rhythm? RegularRegular Regularly IrregularRegularly Irregular Irregularly IrregularIrregularly Irregular Any funny looking complexes? PACsPACs PVCsPVCs PJCsPJCs UnifocalUnifocal MultifocalMultifocal

11 2 nd Degree AV Block Mobitz I or Wenkebach

12 3rd Degree AV Block

13 A-Fib Most common sustained arrhythmia. Arrhythmia Anatomy: Multiple wavelets of re-entry swashing around the atria. The AV node is inundated with cascades of chaotic activity

14 Accelerated Junctional

15 Atrial Flutter 2:1 conduction

16 NSR w/ a 1 st Degree AV Block

17 CHECK YOUR LEADS!!! Asystole

18 Junctional

19 NSR w/ BBB

20 NSR w/ Multifocal PVCs

21 NSR w/ PAC

22 NSR w/ PJC

23 NSR w/ Unifocal Couplet PVCs

24 NSR w/ a Unifocal PVCs

25 Sinus Bradycardia

26 Sinus Tachycardia

27 SVT

28 Is someone moving the cables? Could be artifact! VFIB!

29 V-Tach

30 Paced rate of 80 w/ capture

31 ADVICE: When youve think youve looked at enough EKG strips…Look at more! Practice…Practice & more Practice!

32


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